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ARRHYTHMIAS
Lawver
2012
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CARDIAC WAVES
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P WAVE
Q WAVE
R WAVE
S WAVE
T WAVE
U WAVE
BASELINE
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CARDIAC WAVES
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P WAVE – (ATRIAL
DEPOLARIZATION)
ELECTRICAL IMPULSE
ORIGINATING AT THE SA
NODE AND MOVING
THROUGH BOTH ATRIA
CAUSING ATRIAL
CONTACTION AND
BEING DELAYED AT THE
AV NODE; INTRINSIC
RATE 60-100 IMPULSES
PER MINUTE
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CARDIAC WAVES
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QRS COMPLEX –
(VENTRICULAR
DEPOLARIZATION)
ELECTRICAL IMPULSE
TRAVELING FROM THE AV
NODE THROUGH THE AV
BUNDLE, THE BUNDLE
BRANCHES AND PURKINJE
FIBERS CAUSING
VENTRICULAR
CONTRACTION; INTRINSIC
RATE 40-60 IMPULSES PER
MINUTE
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CARDIAC WAVES
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T WAVE –
(VENTRICULAR
REPOLARIZATION)
ABSENCE OF
ELECTRICAL
IMPULSE,
VENTRICULAR
RELAXATION
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CARDIAC WAVES
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BASELINE (POLARIZATION)
COMPLETE
ABSENCE OF
ELECTRICAL
ACTIVITY
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CARDIAC WAVES
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U WAVE
OCCASSIONALLY A U
WAVE APPEARS
THIS IS ALWAYS
ABNORMAL
MAY INDICATE A
POTASSIUM
DEFICIENCY OR OTHER
METABOLIC
ABNORMALITY
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CARDIAC CYCLE
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ONE COMPLETE HEART BEAT
CONSISTS OF A P WAVE, FOLLOWED BY A
QRS COMPLEX, AND A T WAVE WHEN ALL IS
FUNCTIONING NORMALLY
BY EVALUATING WAVES WE ARE ABLE TO
DETERMINE IF THE ELECTRICAL
CONDUCTION SYSTEM, AND THEREFORE
CARDIAC CONTRACTION IS OCCURRING
NORMALLY
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NORMAL SINUS RHYTHM
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THIS IS WHAT IT LOOKS LIKE WHEN EVERYTHING IS
FUNCTIONING CORRECTLY
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ARRHYTHMIA VS.
DYSRRHYTHMIA
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ESSENTIALLY THE SAME CONCEPT
DYSRRHYTHMIA IS PROBABLY MORE
ACCURATE
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EVALUATING A RHYTHM STRIP
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MUST HAVE A GOOD 6 SECOND TRACING OF
THE SAME LEAD
MUST UNDERSTAND HOW THE EKG PAPER
READS
MUST UNDERSTAND CARDIAC WAVES
MUST UNDERSTAND INTERVALS
MUST BE ABLE TO FOLLOW DIRECTIONS AND
EVALUATE METHODICALLY
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READING EKG PAPER
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THE HORIZONTAL
PLANE MEASURES
TIME / DURATION
THE VERTICAL
PLANE MEASURES
AMPLITUDE /
STRENGTH
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READING EKG PAPER
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HORIZONTALLY EACH SMALL BOX EQUALS
0.04 SECONDS
HORIZONTALLY EACH LARGE BOX EQUALS
0.20 SECONDS
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READING EKG PAPER
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VERTICALLY EACH SMALL BOX EQUALS 1
MILLIMETER OR 1 MILLIVOLT
VERTICALLY EACH LARGE BOX EQUALS 5
MILLIMETERS OR 5 MILLIVOLTS
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STEPS TO EVALUATE A
RHYTHM STIP
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STEP ONE
EVALUATE FOR THE PRESENCE OF ALL WAVES
EVALUATE THE APPEARANCE OF ALL WAVES
EVALUATE THE CONSISTENCY OF ALL WAVES
ARE THE WAVES IN THIS STRIP ALL PRESENT, NORMAL AND
CONSISTENT?
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STEPS TO EVALUATE A
RHYTHM STIP
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STEP TWO
DETERMINE THE ATRIAL HEART RATE
COUNT THE NUMBER OF P WAVES OCCURRING IN 6 SECONDS, AND
MULTIPLY BY 10
NORMAL IS GENERALLY BETWEEN 60 AND 100 BPM, WITH THE IDEAL
RATE BETWEEN 60 AND 80 BPM
WHAT IS THE ATRIAL RATE OF THIS STRIP?
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STEPS TO EVALUATE A
RHYTHM STIP
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STEP THREE
DETERMINE THE VENTRICULAR HEART RATE
COUNT THE NUMBER OF QRS COMPLEXES OCCURRING IN 6 SECONDS, MULTIPLY BY 10
NORMAL IS GENERALLY BETWEEN 60 AND 100 BPM, WITH THE IDEAL RATE IS BETWEEN 60
AND 80 BPM
WHAT IS THE VENTRICAL RATE OF THIS STRIP?
FINALLY, CHECK TO SEE IF THE ATRIAL AND VENTRICULAR RATES ARE THE SAME
ARE THEY THE SAME IN THIS STRIP?
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STEPS TO EVALUATE A
RHYTHM STIP
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STEP FOUR
MEASURE THE PR INTERVAL OF EACH CARDIAC CYCLE
COUNT THE NUMBER OF SMALL BOXES FROM THE END OF THE
P WAVE TO THE BEGINNING OF THE Q WAVE
NORMAL IS 3 TO 5 SMALL BOXES
WHAT IS THE PR INTERVAL OF THIS STRIP?
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STEPS TO EVALUATE A
RHYTHM STIP
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STEP FIVE
DETERMINE IF ANY ARTIFACTS ARE PRESENT
EVALUATE THE BASELINE FOR WANDERING, SOMATIC TREMOR, AND
AC INTERFERENCE, INTERRUPTION
WANDERING IS DUE TO MOVEMENT OR POOR ELECTRODE CONTACT,
THE TRACE MOVES UP AND DOWN ON THE PAPER, THE TRACE IS NOT
CENTERED
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STEPS TO EVALUATE A
RHYTHM STIP
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STEP FIVE CONTINUED
SOMATIC TREMOR IS DUE TO MUSCLE MOVEMENT AND WILL SHOW JAGGED
PEAKS OF IRREGULAR HEIGHT AND SPACING
AC INTERFERENCE IS DUE TO INTERFERENCE OF ELECTRICAL APPLIANCES
AND WILL SHOW UP AS A SERIES OF UNIFORM SMALL SPIKES
INTERRUPTED BASELINE OCCURS WHEN CURRENT IS INTERRUPTED AND
APPEARS AS ERRATIC MOVEMENT OF THE TRACING TO THE MARGINS
ARE THERE ANY ARTIFACTS PRESENT IN THIS STRIP?
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STEPS TO EVALUATE A
RHYTHM STIP
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STEP SIX
EVALUATE THE RHYTHM
MEASURE THE DISTANCE BETWEEN EACH R WAVE
REGULAR INDICATES THE SAME DISTANCE BETWEEN EACH R WAVE
IRREGULAR INDICATES VARYING DISTANCES BETWEEN R WAVE
OCCASSIONALLY WE SAY THAT THE RHYTHM IS “ESSENTIALLY REGULAR” WHEN THE BASE
RHYTHM IS REGULAR WITH JUST AN OCCASSIONAL VARIATION
WHAT IS THE RHYTHM OF THIS STRIP?
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